Diagnostic accuracy of patient history and clinical examination to identify pathology in the lumbar spine of elite gymnasts with MRI as the reference standard.

Diagnostic value of clinical signs for detecting temporomandibular joint disc displacement: a single-center cross-sectional diagnostic accuracy study using magnetic resonance imaging as the reference standard.

Evaluation of clinical and ultrasound-based diagnosis of the long head of the biceps pathologies - a prospective study.

OBJECTIVE To validate the diagnostic properties of orthopedic tests and qualitative and quantitative high-resolution ultrasound-based (HRUS) assessments in the diagnosis of long head of the biceps tendon (LHBT) pathologies. DESIGN Single blind prospective study evaluating orthopedic tests and HRUS diagnostic performances compared to surgery. SETTING Hospital orthopaedic department. PARTICIPANTS Seventy-one adults scheduled for open or arthroscopic shoulder surgery were included within six weeks of their scheduled surgery. INTERVENTION Participants underwent a preoperative clinical examination, including the Speed's, O'Brien's, Uppercut, and Yergason's tests, and palpation of the bicipital groove, as well as both qualitative and quantitative HRUS evaluation of the LHBT. Afterwards, the LHBT was evaluated during surgery to confirm the diagnosis, with the surgeon blinded from the clinical and HRUS examination. MAIN OUTCOME MEASURE(S) Diagnostic properties were determined for 1) each individual orthopedic test and combinations of tests, 2) qualitative HRUS data alone and in combination with orthopedic tests, and 3) quantitative HRUS data. A receiver operating characteristic (ROC) curve was used to assess the ability of quantitative HRUS to discriminate the presence of LHBT tendinopathy. RESULTS The overall diagnostic performance of the orthopedic special tests was low. Qualitative HRUS exhibited promising diagnostic properties for identifying full-thickness tears (Sensitivity 63%, Specificity 86%) and LHBT dislocation/subluxation (Sensitivity 38%, Specificity 81%). However, combining qualitative HRUS with orthopedic tests and participant age yielded the best properties (i.e., improvement in sensitivity and specificity across all LHBT diagnoses). The diagnostic performance of quantitative HRUS varied depending on the cut-off values used; the best results observed using a maximal surface area greater than 21 mm² (Sensitivity 55%, Specificity 86%). CONCLUSION Qualitative HRUS shows promising diagnostic potential but should be used in conjunction with orthopedic tests. Further research is needed to validate these preliminary results and refine the pathological cut-offs values of quantitative HRUS assessments.

TO STUDY THE CORRELATION BETWEEN MAGNETIC RESONANCE IMAGING FINDINGS AND CLINICAL SEVERITYIN PATIENTS WITH LOW BACK PAIN

Higher MRI grades of lumbar degeneration were associated with greater functional disability in patients with LBP, and MRI grading may aid structural assessment in appropriately selected symptomatic patients, but findings should be interpreted in conjunction with clinical evaluation.

Diagnostic Accuracy of Physical Examination Maneuvers for Knee Effusion: An Ultrasound Validation Study

Accuracy of knee effusion diagnosis is improved with US, particularly in patients with elevated BMI or small effusions, and is useful for arthrocentesis planning, and is useful for arthrocentesis planning.

What Is the Diagnostic Accuracy of Clinical Examination and Dynamic Radiographs for Acute Vertebral Compression Fractures in Older Adults? A Prospective Study.

BACKGROUND MRI is considered the reference standard for diagnosing acute vertebral compression fractures (VCFs), but its limited availability in many clinical settings necessitates alternative diagnostic strategies. The diagnostic accuracy of clinical examination and dynamic radiographs in a prospective setting remains insufficiently established. QUESTIONS/PURPOSES (1) What is the diagnostic accuracy of clinical examination findings for detecting acute VCFs? (2) What is the diagnostic accuracy of dynamic radiographs at the patient and vertebral levels? (3) Can a stepwise diagnostic approach integrating clinical examination and dynamic radiographs increase the posttest probability of acute VCF compared with the pretest probability? METHODS Between April 2025 and February 2026, a total of 136 patients age 50 years or older presented with acute low back or thoracolumbar back pain within 3 weeks of onset and were clinically suspected of having an acute VCF. All 136 patients were invited to participate in this prospective study evaluating the diagnostic accuracy of clinical examination and dynamic radiographs for the diagnosis of acute VCF. Of those, all 136 patients agreed to participate, and all 136 had full data sets that were analyzed. The mean ± SD age was 85 ± 8 years, and 71% (97 of 136) were female. We applied the following clinical examination elements in this order: clinical examination was performed first and included history of low-energy trauma, the closed-fist percussion test, and turning-over ability in bed. A positive closed-fist percussion test result was defined as localized pain anatomically corresponding to the suspected vertebral level. Dynamic radiographs were obtained after the initial clinical examination when clinical suspicion of VCF remained and were used as confirmatory tests. These included sitting lateral and supine flexion-extension lateral views. A positive dynamic radiographic test result was defined as a decrease in vertebral body height or a new morphologic change compared with the neutral supine image. MRI was used as the primary reference standard in 63% (86 of 136) of patients; 95% (82 of 86) of these patients underwent MRI within 7 days of the initial radiographic assessment. For patients unable to undergo MRI, CT was used in 28% (38 of 136) and sequential radiographs in 9% (12) as predefined alternative reference standards. A reference standard test was given to every study participant regardless of the result of the clinical examination or the results of dynamic radiographs. A positive MRI result was defined as signal change consistent with bone marrow edema within the vertebral body. A positive CT result was defined as vertebral body collapse or endplate or cortical disruption consistent with an acute compression fracture. A positive result on sequential radiographs was defined as progressive vertebral collapse or a new vertebral deformity during follow-up. Sensitivity, specificity, and likelihood ratios were calculated for each clinical examination maneuver at the patient level. For dynamic radiographs, these diagnostic accuracy measures were calculated at both the patient and vertebral levels. To answer the third research question, we used Bayesian updating to estimate whether a stepwise diagnostic approach integrating clinical examination and dynamic radiographs increased the posttest probability of acute VCF compared with the pretest probability. RESULTS The closed-fist percussion test demonstrated the highest sensitivity among clinical findings (93% [95% confidence interval (CI) 87% to 97%]) but low specificity (20% [95% CI 9% to 38%]). At the patient level, sitting radiographs showed the best overall diagnostic performance, with sensitivity of 77% (95% CI 65% to 85%) and specificity of 86% (95% CI 68% to 95%). At the vertebral level, sitting radiographs achieved very high specificity (99% [95% CI 98% to 99%]) and a strong positive likelihood ratio (positive likelihood ratio = 51), indicating strong rule-in capability. Flexion-extension radiographs demonstrated lower sensitivity (60% [95% CI 47% to 72%]) but high specificity (95% [95% CI 93% to 96%]). A sequential diagnostic approach increased the posttest probability of VCF from 22% to 97%. CONCLUSION The closed-fist percussion test may be useful for initial screening, whereas sitting radiographs provide strong confirmatory value. A stepwise diagnostic approach integrating clinical examination and dynamic radiographs may improve diagnostic efficiency and support more selective use of MRI in routine clinical practice; we have created a freely available online tool to help surgeons make these decisions at the point of care (https://norio-yamamoto.github.io/vcf-bayesian-simulator/). LEVEL OF EVIDENCE Level II, diagnostic study.

Lumbar Magnetic Resonance Imaging Profiles and Their Association with Low Back Pain in Dentists: A Cluster Analysis Study

Age appeared to influence the clinical expression of the disc–facet degenerative profile of the lumbar MRI-derived structural profiles in dentists, suggesting that lumbar MRI findings should be interpreted within a broader, age-sensitive clinical context rather than as isolated determinants of symptoms.